Evidence map›Paper›PMID 30455404›Full record

Observational studyJournal of neurology, neurosurgery, and psychiatry2019

Early versus late anticoagulation for ischaemic stroke associated with atrial fibrillation: multicentre cohort study.

Duncan Wilson, Gareth Ambler, Gargi Banerjee, Clare Shakeshaft, Hannah Cohen, Tarek A Yousry, Rustam Al-Shahi Salman, Gregory Y H Lip, Henry Houlden, Martin M Brown and 4 more

Registry-linked trialOpen access · hybridAbstract readComparative StudyMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of neurology, neurosurgery, and psychiatry, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02513316 (Microbleeds and Genetic Risk Factors to Predict the Risk of Intracranial Haemorrhage in Patients Treated With Anticoagulation Following Cardioembolic Stroke Due to Atrial Fibrillation), which is not on this map. Cited by 35 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
35citing papers in PubMed, 4 pooled it
5.6field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02513316 completednot on this map

Microbleeds and Genetic Risk Factors to Predict the Risk of Intracranial Haemorrhage in Patients Treated With Anticoagulation Following Cardioembolic Stroke Due to Atrial Fibrillation

TypeobservationalSponsorUniversity College, LondonRan2011 to 2017Enrolled2,490ConditionsStroke, Atrial Fibrillation (AF), Intracerebral Haemorrhage (ICH)
3 · Its place in the literature

Who cites it

35 citing papers in PubMed, 4 syntheses or guidelines pooled it, 67 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Guideline
  4. Anticoagulation Timing After Stroke in Atrial Fibrillation: Evidence from a Systematic Review and Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
    Pooled it
  5. Trial
  6. Review
  7. Review
  8. Article
  9. Review
  10. Article
  11. Article
  12. Article
  13. Article
  14. Early or late initiation of dabigatran versus vitamin-K-antagonists in acute ischemic stroke or TIA: The PRODAST study.International journal of stroke : official journal of the International Stroke Society · 2023
    Observational
  15. Article
  16. Review
  17. Review
  18. Review
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 5 institutions in 1 country.

Duncan WilsonDepartment of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery UCL Stroke Research Centre, London, UK.
Gareth AmblerDepartment of Statistical Science, University College London, London, UK.
Gargi BanerjeeDepartment of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery UCL Stroke Research Centre, London, UK.ORCID 0000-0003-0190-7782
Clare ShakeshaftDepartment of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery UCL Stroke Research Centre, London, UK.
Hannah CohenHaemostasis Research Unit, Department of Haematology, University College London, London, UK.
Tarek A YousryLysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
Rustam Al-Shahi SalmanCentre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK.ORCID 0000-0002-2108-9222
Gregory Y H LipInstitute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Henry HouldenDepartment of Molecular Neuroscience, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK.
Martin M BrownDepartment of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery UCL Stroke Research Centre, London, UK.
Keith W MuirInstitute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK.
Hans Rolf JägerLysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
David J WerringDepartment of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery UCL Stroke Research Centre, London, UK d.werring@ucl.ac.uk.
Clinical relevance of Microbleeds in Stroke (CROMIS-2) collaborators
National Hospital for Neurology and Neurosurgery · GBUniversity College London · GBQueen Elizabeth University Hospital · GBUniversity of Birmingham · GBUniversity of Edinburgh · GB

Funding

British Heart Foundation CS/18/2/33719Medical Research Council MR/M009106/1Medical Research Council MR/S01165X/1The Dunhill Medical Trust R380R/1114The Dunhill Medical Trust R605/0717
6 · The paper itself

Abstract

background and purposeThe optimal time to start oral anticoagulant (OAC) in patients with ischaemic stroke due to non-valvular atrial fibrillation (AF) is unknown. We reviewed OAC timing in relation to 90-day clinical outcomes as a post hoc analysis from a prospective multicentre observational study.

methodsWe included patients with data on time to initiation of OAC from CROMIS-2 (Clinical Relevence Of Microbleeds In Stroke-2), a prospective observational inception cohort study of 1490 patients with ischaemic stroke or transient ischaemic attack (TIA) and AF treated with OAC. The primary outcome was the composite outcome of TIA, stroke (ischaemic stroke or intracranial haemorrhage) or death within 90 days of the qualifying stroke or TIA. We performed adjusted logistic regression analyses to compare early (0-4 days) and later (≥5 days or never started) OAC initiation.

resultsWe included 1355 patients, mean age 76 (SD 10), 580 (43%) women. OAC was started early in 358 (26%) patients and later (or not at all) in 997 (74%) patients. The event rate within 90 days was 48/997 (5%) in the late-OAC group (2 intracranial haemorrhages, 18 ischaemic strokes or TIAs and 31 deaths (three deaths were as a result of new ischaemic strokes)) versus 7/358 (2%) in the early-OAC group (5 ischaemic strokes or TIAs and 2 deaths). In adjusted analyses, late OAC was not associated with the composite outcome (adjusted OR 1.17, 95% CI 0.48 to 2.84, p=0.736).

conclusionIn adjusted analyses, early OAC after acute ischaemic stroke or TIA associated with AF was not associated with a difference in the rate of the composite outcome of stroke, TIA or death at 90 days, compared with late OAC. However, despite adjustment for important baseline factors, patients selected for early OAC and late OAC might still have differed in important respects; evaluation of OAC timing in adequately powered randomised trials is required. CLINICAL

trial registrationNCT02513316.

Indexed as

Administration, OralAgedAged, 80 and overAnticoagulantsAtrial FibrillationBrain IschemiaCohort StudiesDrug Administration ScheduleFemaleHumansMaleMiddle AgedStrokeTreatment OutcomeAnticoagulantsanticoagulationatrial fibrillationDOACischaemic strokewarfarin

Identifiers

PMID30455404
PMCPMC6518971
OpenAlexW2901743018

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.